AIDS Healthcare Foundation Cedes Ground in Anti-PrEP Fight

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AIDS Healthcare Foundation (AHF), which has long waged a vociferous and largely isolated battle against Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP), has finally begun to capitulate, offering measured support for the HIV prevention method. After publishing an error-ridden advertisement attacking PrEP in various gay newspapers across the country in June, AHF will release a new ad on August 19 in which the organization presents a series of guidelines for the use of PrEP.

Titled “Reaching Common Ground on PrEP,” the ad includes points that repeat established U.S. guidelines for the use of PrEP. (AHF is presumably addressing the concerns of a gay male audience, since its ad is running in gay newspapers.) For example, the ad says that those who won’t use condoms are the best candidates for PrEP; that everyone taking PrEP should be tested regularly for HIV and sexually transmitted infections; and that physicians should closely monitor PrEP users, counsel them on adherence, and discuss sexual risk.

South Florida Gay News, New York’s Gay City News, Los Angeles’ Frontiers Newsmagazine, the Bay Area Reporter, the Dallas Voice, Atlanta’s GA Voice, and Washington, DC’s The Washington Blade and Metro Weekly will all publish the ad this week.

The ad stands in a stark contrast to AHF’s June missive; the previous take’s provocative tone has been replaced by a more measured and practical approach, one that seems to acknowledge that rapidly increasing numbers of HIV-negative Americans are starting Truvada regardless of AHF’s past campaigning against PrEP. AHF’s categorization of women and youth as “marginalized populations” aside, the ad largely adheres to the facts about PrEP.

However, AHF insists on sticking to its position, frequently voiced by the organization’s confrontational president, Michael Weinstein, that PrEP should not be used as a broad-scale public health approach to fighting HIV.

“At the end of the day, PrEP is an individual option, not a general solution,” Weinstein said in a press release. “We believe PrEP should be prescribed on a case-by-case basis by medical providers working in conjunction with their patients, not as a community-wide public health intervention strategy, as the CDC recommended last summer when it recommended that 500,000 high-risk individuals go on PrEP.”

The press release asserts that “nearly all major PrEP studies” do not support the public health application of PrEP. In fact, all major studies of Truvada among HIV-negative men who have sex with men (MSM) have shown that the drug succeeds in reducing HIV rates among those at high risk of contracting the virus. One recent trial among very high-risk British MSM found that PrEP had an 86 percent success rate. In the past, AHF has gone to lengths to claim that the respective 44 percent and 50 percent effectiveness rates of PrEP seen in two previous major trials represent failures on a public health level, rather than considerable, if not perfect, success in reducing HIV rates.

The argument against PrEP use as a public health intervention is not an obvious component of the current newspaper campaign. It is implied, however, when AHF states that “[t]he goal should be” to treat all people with HIV and ensure that they have an undetectable viral load and are therefore uninfectious. AHF has long insisted on a limited HIV prevention policy of promoting condom use and universal treatment for those living with the virus. This stance aligns with AHF’s status as the largest purveyor of HIV treatment in the world.

Since the advent of PrEP, prevention advocates and public health officials have increasingly argued that Truvada should be encouraged as “a tool in the toolbox” that includes a variety of HIV prevention strategies, including treatment as prevention among HIV-positive people and condom use.

One such advocate is Mitchell Warren, executive director of the global HIV advocacy organization AVAC, who says, “The science is clear: PrEP works when you take it. Thousands of advocates, researchers, policy makers and, most importantly, individuals at risk in the United States and around the world have known this for several years now. I am delighted that AHF has finally joined the rest of us. Their 11 principles are new to them, but are exactly what the rest of us have been advocating.”

AHF’s ad also wisely points out that more research is needed on the likely adherence to PrEP among women, youths, African-Americans and Latinos. Research presented in late July at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, British Columbia, suggested that young MSM and, in particular, young black MSM, may be unlikely to adhere well to PrEP.

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